Guidance for the Prevention and Control of Influenza in the Peri- and Postpartum Settings

Pregnant women have been shown to be at increased risk of severe illness, hospitalizations, and death from complications of influenza. General Prevention Strategies for Seasonal Influenza in Health Care Settings are currently available and apply to all health care settings. Those general strategies outline infection control precautions for all patient care including care of women and newborns within the labor, delivery, recovery, and postpartum settings. The following highlights some of the important recommendations contained in this guidance as well as supplemental strategies specific to hospitalized pregnant, intrapartum, and postpartum women and their newborns during the birth hospitalization.Additional information about the use of antiviral drugs in pregnant and postpartum women is also available on the CDC web site. While data are limited, these recommendations are based upon evidence available to date, and will be revised accordingly if new data are available in the future.

Pre-Delivery

• Prior to delivery, a hospitalized pregnant woman with suspected or laboratory-confirmed influenza should be placed in a private room on Droplet Precautions and instructed to follow respiratory hygiene and cough etiquette, including wearing a facemask, if being transported outside of her room.
• Health care personnel entering rooms of pregnant women with suspected or confirmed influenza should adhere to Standard and Droplet Precautions, including donning a facemask upon entry into the room, performing hand hygiene, wearing gloves for any contact with potentially infectious materials, and wearing gowns for any patient-care activity where contact with body fluids may occur.
• Droplet Precautions should be continued for hospitalized patients with suspected or confirmed influenza for 7 days after illness onset or until 24 hours after the resolution of fever and respiratory symptoms, whichever is longer, while the patient is in a health care facility.
  • Patients placed on Droplet Precautions should be discharged from medical care when clinically appropriate, not based on the period of potential virus shedding or recommended duration of Droplet Precautions.
• The peripartum patient and her family members and other visitors should be informed of the risks of influenza virus transmission and instructed to adhere to respiratory hygiene and cough etiquette, hand hygiene, and use of personal protective equipment (PPE) according to current facility policy.

During Delivery

• Patients with suspected or confirmed influenza who are in the labor and delivery suite should remain on Droplet Precautions.
• Health care personnel in the delivery suite should adhere to Standard and Droplet Precautions, including practicing hand hygiene before and after handling the newborn.

After Delivery

• Although it is well-recognized that the ideal setting for care of a healthy-term newborn while in the hospital is within the mother’s room, newborns that become infected with influenza are at increased risk for severe complications. To reduce the risk of influenza in the newborn, CDC recommends that facilities consider temporarily separating the mother who is ill with suspected or confirmed influenza from her baby following delivery during the hospital stay.
  • Throughout the course of temporary separation, all feedings should be provided by a healthy caregiver if possible. Mothers who intend to breastfeed should be encouraged to express their milk.
• The optimal length of temporary separation has not been established, and will need to be assessed on a case-by-case basis after considering many factors.
• Guidelines during the 2009 H1N1 pandemic recommended that:
  • Separation should continue until all of the following were met:
    • the mother had received antiviral treatment for >48 hours
    • the mother was afebrile without antipyretics for >24 hours, and
    • the mother was able to control her cough and respiratory secretions.
• If co-location (sometimes referred to as “rooming in”) of the newborn with his/her ill mother in the same hospital room is unavoidable due to a hospital’s configuration, nursery constraints, lack of availability of isolation rooms, or other reasons, facilities should consider implementing measures to reduce influenza-virus exposure of the newborn including:
  • using engineering controls like physical barriers (e.g., a curtain between the mother and newborn)
  • keeping the newborn ≥6 feet away from the ill mother
  • ensuring a healthy adult is present to care for the newborn
• If co-location of the newborn with his/her mother is unavoidable, and if no other healthy adult is present in the room to care for the newborn, a mother with suspected or confirmed influenza should put on a facemask and then practice hand hygiene before each feeding or other close contact with her newborn. The facemask should remain in place during contact with the newborn. These practices should continue while the mother is on Droplet Precautions.
  • Once contact between mother and infant is resumed, Droplet Precautions for influenza should continue to be observed until at least 7 days after maternal illness onset.

Nursery

• If a newborn infant of a mother with suspected or confirmed influenza is housed in the hospital nursery instead of the mother’s room, infants without symptoms of influenza can be cared for by a non-ill person using Standard Precautions and be closely observed for signs of infection.
• Symptomatic mothers, care givers, and family members should not enter the nursery.
• A newborn that develops symptoms should be placed on Droplet Precautions.

Visitors

• Visitors should be limited to persons who are necessary for the patient’s emotional well-being and care. Visitors who have been in contact with an infected patient before and during her hospitalization are a possible source of influenza for other patients, visitors, and staff. Visitors should be screened for symptoms of acute respiratory illness before being allowed to enter the hospital or unit.
• Facilities should provide instruction, before visitors enter patients’ rooms, on hand hygiene, limiting surfaces touched, and use of personal protective equipment (PPE) according to current facility policy while in the patient’s room.
• Visitors should be instructed to limit their movement within the facility.

Before Hospital Discharge

• Influenza vaccination should be strongly encouraged and, when possible, provided for any susceptible or unvaccinated family members or caregivers who will be in contact with the newborn.
• Caregivers should be advised to:
  • contact their health care provider promptly if the newborn develops symptoms that suggest influenza virus infection.
  • isolate any individuals in the home who become ill in order to minimize exposure of the newborn and mother.
  • if possible, have vaccinated non-ill adults provide care to the newborn at home until the mother’s illness resolves.
  • ensure that the ill postpartum woman follows hand hygiene and respiratory hygiene and cough etiquette when having contact with her newborn.